Table 3.
Qualitative Profile of Drug Shortages in Each Hospital
| Country; No. (%) of Shortages | ||||||
|---|---|---|---|---|---|---|
|
| ||||||
| Variable | Canada (n = 84) | France (n = 62) | Belgium (n = 46) | Spain (n = 28) | Switzerland (n = 98) | Total (n = 318) |
| Data source used to identify drug shortages | ||||||
| Wholesaler | 82 (98) | 60 (97) | 0 (0) | 2 (7) | 0 (0) | 144 (45.3) |
| Manufacturer | 2 (2) | 0 (0) | 46 (100) | 25 (89) | 98 (100) | 171 (53.8) |
| Website | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0.0) |
| Drug regulatory authorities | 0 (0) | 2 (3) | 0 (0) | 1 (4) | 0 (0) | 3 (0.9) |
| Other institutions | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0.0) |
| Other | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0.0) |
|
| ||||||
| Cause of shortage | ||||||
| Shortage of raw material | 0 (0) | 1 (2) | 0 (0) | 2 (7) | 2 (2) | 5 (1.6) |
| Manufacturing problem | 0 (0) | 2 (3) | 4 (9) | 0 (0) | 0 (0) | 6 (1.9) |
| Quality defect | 0 (0) | 0 (0) | 1 (2) | 0 (0) | 1 (1) | 2 (0.6) |
| Increasing demand | 54 (64) | 0 (0) | 0 (0) | 0 (0) | 9 (9) | 63 (19.8) |
| Product discontinued | 4 (5) | 0 (0) | 0 (0) | 1 (4) | 0 (0) | 5 (1.6) |
| Natural disaster or other incident | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (1) | 1 (0.3) |
| Unknown | 26 (31) | 59 (95) | 40 (87) | 25 (89) | 85 (87) | 235 (73.9) |
| Other | 0 (0) | 0 (0) | 1 (2) | 0 (0) | 0 (0) | 1 (0.3) |
|
| ||||||
| Presence of national directive or regulation for managing shortage* | ||||||
| Yes | 0 (0) | 2 (3) | 0 (0) | 10 (36) | 1 (1) | 13 (4.1) |
| No | 84 (100) | 60 (97) | 46 (100) | 18 (64) | 97 (99) | 305 (95.9) |
|
| ||||||
| Personnel in charge of managing shortage† | ||||||
| Pharmacist | 2 (2) | 7 (11) | 46 (100) | 6 (21) | 98 (100) | 159 (50.0) |
| Pharmacy technicians | 5 (6) | 55 (89) | 0 (0) | 0 (0) | 0 (0) | 60 (18.9) |
| Administrative personnel or management | 77 (92) | 0 (0) | 0 (0) | 20 (71) | 0 (0) | 97 (30.5) |
| Other | 0 0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0.0) |
| Unknown | 0 (0) | 0 (0) | 0 (0) | 2 (7) | 0 (0) | 2 (0.6) |
|
| ||||||
| Estimated time spent on managing shortage | ||||||
| < 15 min | 57 (68) | 55 (89) | 0 (0) | 5 (18) | 0 (0) | 117 (36.8) |
| 15–30 min | 16 (19) | 0 (0) | 46 (100) | 5 (18) | 0 (0) | 67 (21.1) |
| 31–60 min | 0 (0) | 2 (3) | 0 (0) | 6 (21) | 85 (87) | 93 (29.2) |
| 61–120 min | 0 (0) | 0 (0) | 0 (0) | 1 (4) | 7 (7) | 8 (2.5) |
| > 120 min | 3 (4) | 5 (8) | 0 (0) | 6 (21) | 6 (6) | 20 (6.3) |
| Unknown | 8 (10) | 0 (0) | 0 (0) | 5 (18) | 0 (0) | 13 (4.1) |
|
| ||||||
| Actions implemented during shortage | ||||||
| Used product still in stock‡ | 30 (36) | 53 (85) | 5 (11) | 1 (4) | 4 (4) | 93 (29.2) |
| Obtained drug from another health facility | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0.0) |
| Obtained drug from another supplier | 21 (25) | 0 (0) | 4 (9) | 2 (7) | 0 (00) | 27 (8.5) |
| Used another product | 11 (13) | 0 (0) | 37 (80) | 17 (61) | 75 (77) | 140 (44.0) |
| Imported drug from another country | 0 (0) | 2 (3) | 0 (0) | 3 (11) | 13 (13) | 18 (5.7) |
| Modified practices of the health facility | 10 (12) | 5 (8) | 0 (0) | 1 (4) | 1 (1) | 17 (5.3) |
| Other | 2 (2) | 0 (0) | 0 (0) | 3 (11) | 5 (5) | 10 (3.1) |
| Unknown | 10 (12) | 2 (3) | NA | 1 (4) | NA | 13 (4.1) |
NA = not applicable.
Depending on the type of drug in short supply, the drug regulatory authorities may or may not issue recommendations to ensure patient safety during the shortage.
The person managing a shortage may differ according to the type of drug in shortage or the reason for the shortage; for example, some actions implemented during a shortage may require the skills of a pharmacist.
Health facilities usually have a stock of about 2 weeks for the main drugs used. Therefore, when a drug is in short supply at the manufacturer, it may take a few days or a week before the hospital’s stock declines to zero. Sometimes, however, the stock is insufficient to meet needs during a manufacturer’s shortage, and other actions must be implemented.